1. Chapter 20: Sexual Disorders: Sexual Dysfunctions and Paraphilias Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

2. 2 Sexual Dysfunctions Etiology Physical/biologic  Disease processes  Medications Psychologic/behavioral  Earlier experiences  Anxiety/stress  Misinformation Couple-oriented factors

3. 3 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Disorders  Sexual desire disorders  Sexual arousal disorders  Female arousal  Male erectile disorder  Orgasmic disorders  Delay or absence of orgasm  Premature ejaculation

4. 4 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Disorders, cont’d.  Sexual pain disorders  Sexual dysfunction due to medical condition  Substance-induced  Not otherwise specified

5. 5 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Discharge Criteria  Expresses satisfaction with sexuality  Evidences knowledge of disorder  Uses strategies appropriate to treat disorder  Communicates with partner  Copes with frustrations/setbacks

6. 6 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Assessment  Nurse: Examine own feelings  Establish rapport before progressing to sexuality information  Sexual history

7. 7 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Nursing Diagnoses  Anxiety  Risk-prone health behavior  Impaired comfort  Impaired verbal communication  Ineffective coping  Defensive coping  Fear  Hopelessness

8. 8 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Nursing Diagnoses, cont’d.  Deficient knowledge  Chronic pain  Ineffective role performance  Situational low self-esteem  Sexual dysfunction  Ineffective sexuality pattern  Social isolation

9. 9 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Client Outcomes Sexual Dysfunctions Client Outcomes IndividualizedExamples:  Verbalize problem.  Identify feelings.  Schedule physical examination.*  Participate in sex therapy.*  Practice recommended strategies. *If indicated.

10. 10 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Planning Based on:  Realistic criteria  Mutually selected goals  Client willingness to participate

11. 11 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Implementation  View problem as couple-oriented  Education  Counseling  Identification of strategies  Referral  Support

12. 12 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Nursing Interventions  Teach sexual response cycle.  Teach about sexual dysfunction.  Help enhance communication skills related to intimacy/sexuality.  Support exploration of fears/anxiety.  Encourage positive self-talk, body image, exercises to increase self-esteem.  Refer as appropriate.

13. 13 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Medical Testing (Male)  Nocturnal penile tumescence  Plethysmography  Testosterone and prolactin levels  Penile brachial index  Ultrasound

14. 14 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Medical Testing (Female)  Plethysmography  Estradiol level  Testosterone level

15. 15 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Treatment Modalities (Male)  Sildenafil (Viagra)  Apomorphine (Spontane)  SSRIs  Hormone replacement  Yohimbine  Intracarpal injections  Prosthetic device  Stop-start technique

16. 16 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Treatment Modalities (Female)  Yohimbine  Estrogen  Testosterone  EROS-CTD  Vaginal dilators and relaxation

17. 17 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Sexual Dysfunctions Treatment Modalities (Both)  Sensate focus  Homework assignments  Supportive counseling  Education  Cognitive restructuring  Masturbation training  PLISSIT

18. 18 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias: Sexual Deviations Recurrent, intense, sexually-arousing fantasies, sexual urges, or behaviors involving nonhuman objects or suffering/humiliation of self, partner, children, or other nonconsenting persons

19. 19 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias  Exhibitionism  Fetishism  Frotteurism  Pedophilia  Sexual masochism  Sexual sadism  Transvestic fetishism  Voyeurism  Not otherwise specified

20. 20 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Etiology  Biologic factors  Chromosomal  Hormonal  Experiential factors  History of sexual abuse  Environmental factors  Hereditary predisposition

21. 21 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Discharge Criteria  States nature of paraphilia: impact on self and others  Identifies triggers  Develops relapse prevention strategies  Communicates and problem-solves appropriately  Practices coping strategies  Identifies support systems

22. 22 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Assessment  Perceptual disturbances  Cognitive distortions  Denial  Rationalization  Disturbances in feelings  Lack of remorse  Relating disturbances

23. 23 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Nursing Diagnoses  Ineffective coping  Ineffective denial  Interrupted family processes  Deficient knowledge  Noncompliance  Ineffective sexuality pattern  Impaired social interaction  Risk for other-directed violence

24. 24 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Outcome Identification  State two sexually inappropriate behaviors.  Identify triggers.  Describe two coping strategies.  List relapse prevention strategies.  Actively participate in group therapy.  Verbalize two appropriate sexual outlets.  Explain importance of medication compliance.

25. 25 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Planning  Involve client  Client-centered outcomes  Mutually agreed on  Realistic  Affected by cognitive distortions

26. 26 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Nursing Interventions  Help client confront cognitive distortions:  Direct questions  Confrontation  Journal writing  Educate client and significant others about:  Disorder  Treatment  Methods of relapse prevention

27. 27 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Nursing Interventions, cont’d.  Enhance compliance with treatment.  Provide results of research.  Teach coping strategies, assertiveness, and problem solving.  Promote social skills development.

28. 28 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Pharmacologic Treatment  Medroxyprogesterone acetate (Depo-Provera)  Leuprolide (Lupron Depot)  Flutamide  SSRIs

29. 29 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Paraphilias Psychotherapy/Psychoeducation  Address cognitive distortions  Identify triggers  Relapse prevention strategies  Treatment compliance  Self-esteem  Coping strategies  Problem solving